Health Impact Assessment: Concepts and Guidelines for the Americas Health Impact Assessment: Concepts and Guidelines for the Americas Special Program on Sustainable Development and Health Equity Washington, D.C., 2013 Also published in Spanish (2013) with the title: Conceptos y guía de análisis de impacto en salud para la Región de las Américas ISBN 978-92-75-31805-8 PAHO HQ Library Cataloguing-in-Publication Data ************************************************************************ Pan American Health Organization. Health Impact Assessment: Concepts and Guidelines for the Americas. Washington, DC : PAHO, 2013. 1. Health Impact Assessment – trends. 2. Public Policies. 3. Environmental Impact. 4. Equity in Health. 5. Coverage Equity. 6. Americas. I. Title. II. Raúl Sánchez-Kobashi M. III. Antonio J. Berlanga-Taylor. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. Table of Contents Abbreviations .............................................................................................................................................................v I. Introduction ..........................................................................................................................................1 II. Impact Assessment ...........................................................................................................................5 II.1 Origin and Definition of Impact Assessment (IA) .........................................................................7 II.2 Impact Evaluation or Impact Assessment? ��������������������������������������������������������������������������������10 II.3 Methods for Impact Assessment .................................................................................................11 II.4 Impact Assessment in the Public Policy-Making Process .........................................................13 II.5 Culture of Evaluation and Health Impact Assessment in the Americas .................................14 III. Health Impact Assessment ..........................................................................................................19 III.1 Introduction, Definition, and Origin of Health Impact Assessment ..........................................21 III.2 Concepts of Health Impact Assessment �����������������������������������������������������������������������������������24 III.3 Social Determinants of Health and Health Inequities ...............................................................30 III.4 Health in All Policies �����������������������������������������������������������������������������������������������������������������������33 III.5 Implementation of Health Impact Assessment at the Global and Regional Levels .............34 III.6 Legislation Related to Health Impact Assessment ....................................................................38 IV. Methodology for Health Impact Assessment.........................................................................39 IV.1 Scientific Basis of HIA Methodology ............................................................................................41 IV.2 Steps to Take when Preparing a Health Impact Assessment ...................................................43 IV.3 Minimum Elements and General Guidelines for Conducting a Health Impact Assessment ...........................................................................................................55 V. Examples of Health Impact Assessment ..................................................................................57 V.1 The Example of the United States: Strategic Level �������������������������������������������������������������������59 V.2 The European Example: Policy Level �������������������������������������������������������������������������������������������60 VI. Conclusions ........................................................................................................................................61 References .................................................................................................................................................................65 Health Impact Assessment: Concepts and Guidelines for the Americas iii Annexes ......................................................................................................................................................................73 Figures Figure II.1 Basic steps for carrying out and impact assessment ......................................................................11 Figure II.2 Impact assessment in the planning process .....................................................................................14 Figure III.1 Levels of decision-making ....................................................................................................................21 Figure III.2 Milestones in the evolution of health impact assessment ..............................................................23 Figure III.3 Causal relations in an alcohol policy .................................................................................................27 Figure III.4 Type of evidence used in health impact assessment .....................................................................28 Figure III.5 Conceptual framework of social determinants of health, WHO Commission on Social Determinants of Health .........................................................................................................................31 Figure III.6 Probability of reporting poor health in people over age 15, by income bracket (Chile, 2000) .............................................................................................................................32 Figure III.7 Effects of combined nutritional supplementation and psychosocial stimulation on stunted children in a two-year intervention study in Jamaica .....................................................................32 Figure III.8 Distribution of infant mortality by expenditure decile* (Mexico, 2000) .........................................33 Figure IV.1 Flowchart showing the roles of publicly available evidence, local data, and stakeholders’ experience in the process of health impact assessment (HIA) ����������������������������������������������������41 Figure IV.2 Steps to follow in a health impact assessment ���������������������������������������������������������������������������������54 Tables Table III.1 Schools of thought in the area of health impact assessment ............................................. ���������25 Table III.2 Types of health impact assessment ���������������������������������������������������������������������������������������������������� 29 Table III.3 Number of health impact assessments prepared per country in Europe (1994–2005) .............35 Table III.4 Health impact assessment by sector in Europe (1994-2005) .......................................................... 36 Table IV.1 Format of a health impact matrix ...................................................................................................... 51 Table IV.2 Matrix for summarizing the results of the health impact assessment and formulating the recommendations ................................................................................................53 iv Health Impact Assessment: Concepts and Guidelines for the Americas Abbreviations CEQA California Environmental Quality Act CGE Computable general equilibrium CSDH Commission on Social Determinants of Health EC European Commission ECPH European Centre for Health Policy EHIA Environmental and health impact assessment